Medicaid-Medicare Eligibility

This site provides general information only and not legal advice. The law is complex and changes frequently. Before you apply any information to a particular situation, call Pro Seniors’ Legal Hotline or consult an attorney in elder law. The numbers listed below change annually on the effective date listed in the first column.

Application Forms for Medicare Premium Assistance Programs

The Ohio Department of Medicaid prefers Form ODM 07216 when applying for Medicare Premium Assistance Programs. However, Medicare Premium Assistance Programs are not mentioned on this form. Therefore, we have provided a form that highlights the areas that need to be completed, and we have also provided the old form (ODM 07103) which is still being accepted by some counties. Please be sure to advise your county caseworker of all members of your household.

Pamphlets

For more general information regarding Medicare and Medicaid see our complete list of pamphlet titles. Pro Seniors provides legal information pamphlets on a variety of subjects. Single copies are available to individuals free of charge. Contact Pro Seniors, Inc. and we will mail you pamphlets which are of interest to you.

Ohio Department of Medicaid Resources and Rules

Click here for a handy list of ODM’s resources and rules for the Medicaid practitioner or curious individual. Pro Seniors makes every effort to update the list with the most current rules. However, we can neither guarantee the list’s accuracy nor its appropriateness for any specific purpose.

Medicaid Eligibility Standards

Pro Seniors receives frequent requests from professionals for the current Medicaid eligibility standards. Pro Seniors makes every effort to update the numbers below with the most current releases. However, we cannot guarantee the accuracy of the numbers below, nor their appropriateness for any specific purpose.

Part B

Non-Income Related or Standard Premium (Monthly)

The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017. However, a statutory “hold harmless” provision applies each year to about 70 percent of enrollees. For these enrollees, any increase in Part B premiums must be lower than the increase in their Social Security benefits. After several years of no or very small increases, Social Security benefits will increase by 2.0 percent in 2018 due to the Cost of Living adjustment. Therefore, some beneficiaries who were held harmless against Part B premiums increases in prior years will have a premium increase in 2018. About 28 percent of all Part B enrollees are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase;
Generally, see,
42 U.S.C. 1395r(f); and
Medicare 2018 Parts A & B Fact Sheet.

Married Couples
Filing Separately

2018

2017

Note: Couples filing joint returns have twice the above income limits before their Part B premiums are increased to the next level. But married couples filing separately are subject to a special rate increase:

2016 Separate tax return with modified adjusted gross income

$134.00 ---------------------
up to $85,000

$134.00 ---------------------
up to $85,000

$428.60 ---------------------
More than $85,000

$428.60 ---------------------
More than $85,000

Part B

2018

2017

Deductible (Annual)
(In 2005 this deductible was indexed to the increase
in the average cost of Part B services)

$183

$183

Co-Pay (Per Service)

20%

20%

Part D

Part D Income Related
Premium Adjustment (Monthly)

Medicare Part D prescription drug plan premiums vary from plan to plan. Beginning in 2011, Part D enrollees whose incomes exceed the same thresholds that apply to higher income Part B enrollees must also pay a monthly adjustment amount. The regular plan premium is paid to the Part D plan, and the income-related adjustment is paid to Medicare .

Married Couples Filing Separately

2018

2017

Note: Couples filing joint returns have twice the above income limits before their Part D premiums are increased to the next level. But married couples filing separately are subject to a special rate increase:

Part D Low Income Subsidy Eligibility

Ohio
Regional Benchmark
[maximum premium subsidy provided to people who get the full
Part D low-income subsidy (LIS)/Extra Help] (Source)

$31.95

$32.30

Max Monthly Income Eligibility for Extra Help Program (150% FPL)

Single Person

$1,508

$1,508

Couples

$2,030

$2,030

Max Resource Eligibility for Extra Help Program (with burial exclusion) (If no intention to use a portion of assets for funeral or burial expenses, subtract $1,500 for single and $3,000 from couple's resource limit)
[Indexed to CPI] [See,
SS POMS
Medicare Part D Extra Help]